Common Problem

Dental Abscesses

Dental abscesses can be painful but they can be treated relatively easily. A dental abscess is formed when the dental pulp in the middle of the tooth dies and the pulp chamber becomes infected. The build-up of pus can raise the tooth up within the socket, making it feel tender when you bite down.

Tooth abscesses can make your jaw ache and feel tender when you chew. If the abscess bursts, the pain may go, but don't let that stop you seeking treatment. It's important that you see your dentist to make sure the problem doesn't come back. Your dentist will discuss with you the possibilities of placing a root filling in the tooth to prevent this from happening.
Avoiding treatment or putting it off may be one of the reasons for an abscess starting. They occur when tooth decay is left untreated and reaches the dental pulp (the inside of the tooth which holds the blood supply and the nerves), which then becomes infected and dies. The bacteria then spread into the root of the tooth to form an abscess.  

Dental abscesses are fairly easy to diagnose - for example, you may find that pain is worse if you are pressing or chewing on the affected tooth. If the pain is less easy to define, your dentist will tap the teeth to determine which one is tender.  The dentist may use an x-ray as part of the diagnosis, although the early stages of an abscess may not show.
To be able to treat a tooth with an abscess your dentist will first need to deal with the infection. They will do this with antibiotics. You may also need to take painkillers for about 24 hours to give the antibiotics time to work. Your dentist will then give you an appointment around a week later. Although the pain will have gone away it is essential to have further treatment to prevent the abscess coming back.

Removing the affected tooth will solve the problem but your dentist is more likely to try to save the tooth by drilling into the abscess and releasing the pus. They will then give you what is known as root canal treatment - placing a root filling in the tooth to block off the pulp chamber and nerve canal and stop the infection returning. The tooth can then be restored with a normal filling or crown. In some cases if your gum is badly swollen and contains pus your dentist may drain it to release the pressure.

Dry mouth

We all suffer from a dry mouth from time to time, but for some people the condition is more long-lasting. Xerostomia is a condition where the mouth becomes very dry and can make people more susceptible to dental problems such as tooth decay or cause problems for denture wearers.

There are lots of different reasons why people get dry mouth, and there are things that you can do both to ease the condition and help prevent problems with your teeth.
Some prescription drugs and medicines can cause dry mouth as a side effect, especially treatments for depression and high blood pressure. Also, certain medical conditions affect the salivary glands, so they don't produce as much saliva and the mouth tends to be more dry.

Xerostomia can lead to dryness, a burning or sore feeling in the mouth or a bad taste. You may also have difficulty swallowing and speaking. If you wear dentures, you may find they become loose and cause sore areas.

Making sure you don't get dehydrated by drinking plenty of fluids can help. Also, doctors can prescribe artificial saliva which comes as a spray to help moisten the mouth. Talk to your doctor about the medicines you take to see if there are suitable alternatives less likely to cause dry mouth. Some people find sucking sweets, or chewing gum helps produce more saliva, but take special care that these don't contain sugar as this could cause more tooth decay.

Snoring

We all snore from time to time, usually if we're nursing a cold or a blocked nose. For some people, though, snoring is a long term condition which can be distressing for them and their partners. In these cases, dentists may be able to help.
Snoring happens when the soft palate and soft tissues in the throat vibrate together. Throat muscles relax during sleep, like all muscles, and this reduces the size of the airway. A dentist may be able to fit a special appliance which can be worn in the mouth to pull the lower jaw and tongue forward, keeping the airway open and reducing the chance of snoring.

How to prevent snoring

Snoring happens when the soft palate and soft tissues in the throat vibrate together. Throat muscles relax during sleep, like all muscles, and this reduces the size of the airway. If you're a sufferer - or if your partner is - try these possible solutions:

• Cut back on alcohol or sedatives and stop smoking
• Try losing weight
• Change your sleeping position
• Ask your dentist about special appliances to open up the airway. Click here clickable link to Can a dentist do anything about snoring?) for more details
• Ask your doctor or pharmacist about drugs to reduce nasal congestion

Disability access to dental practices

Dentists want to make treatment as accessible as possible, for as many people as possible. New legislation means that, by 2004, they will have to make some adjustments to their practices to ensure wheelchair access and also provide things like grab rails and ramps. Some practices may be exempt if they are in listed buildings, but you can check this with your local authority.

Treatments

Check ups

The dentist uses your check-up to see how healthy your mouth is, whether you might need some work done and, in the case of children, how the teeth are growing and developing. The dentist will have a good look round inside your mouth, checking the teeth, as well as your tongue and the roof of your mouth. The dentist will also look at your face and neck and feel under your jaw.
As well as looking in your mouth, the dentist will ask you some questions, like whether you have had any pain or sensitivity in your teeth or gums recently, what your general health is like, whether you're on any medication at the moment, what your diet is like and whether you smoke or drink alcohol.

Crowns

A crown is like a special sleeve made of metal or porcelain, or both, that goes over a damaged or weak tooth.  Your dentist will match it up to the shape and colour of your other teeth so it will look natural. The crown will probably last for many years, depending on the health of the tooth underneath. To find out more about crowns

Treating gum disease

Gum disease can be treated easily by a dentist - and you can get tips on how best to brush your teeth to prevent it in the future.

One thing your dentist is likely to do is to scale your teeth. This removes the hardened plaque - known as tartar or calculus - from the tooth, especially behind your teeth and just below the gum line. To find out more about the scale and polish, click here (clickable link to What is a scale and polish?)

If you have advanced gum disease, your dentist may advise that you have a longer, more intensive treatment. This is known as root planing or curretage, and is basically an extension of the more usual scale and polish. The dentist - or hygienist - will give your teeth a really deep clean, going below the gum line and clearing any pockets of plaque. They will also be able to remove any plaque and tartar from the roots of your teeth.

Tooth Extraction

Having a tooth out is the same as having an operation and, because of this, you must look after the area to speed healing and to reduce the risk of infection. Here are some pointers:

• For the first 24 hours, try to avoid eating hot food, don't smoke, don't drink any alcohol and try not to disturb any blood clot which might have formed.
• Don't rinse your mouth for six hours after extraction. After that, rinse gently with warm salty water - half a teaspoon of salt in a glass of water is enough.
• Brush your teeth as normal to keep your mouth as clean as possible.
• You may feel some small pieces of bone work their way out of the socket - don't worry, this is perfectly normal.
• There may be some swelling and a bit of discomfort in the first two to three days. If you need to, take some ordinary painkillers - aspirin, ibuprofen or paracetomol will be fine.
• If you feel pain immediately after the tooth has been removed, it might be where the blood clot has broken down leaving an empty hole in the gum. This is called a 'dry socket' and will need to be looked at by your dentist. Simply go back and the dentist will pack the wound to ease your discomfort.

Your dentist may have given you some gauze to place onto the area where the tooth has been removed - if not, a clean cloth handkerchief will do just as well (but not a paper tissue).

• Roll it into a small firm pad large enough to fit over the gap (probably around 1cm by 3cm).
• Sit up and gently clear away any blood clots around the gap using the gauze or hanky.
• Put a clean pad over the gap (from tongue side to cheek side) and bite down on it firmly for 10 to 15 minutes.
• Take the pad off and check whether the bleeding has stopped. If not, apply a fresh pad and contact your dentist.

Oral Hygiene

Taking care of your oral hygiene is important at any age, but when you're older there are some things to which you need to pay special attention. This section gives you top tips to keep your mouth tip-top!

Brushing

Brushing your teeth properly is vital to keeping them healthy. This is even true if you have dentures, because any leftover food or drink could cause gum irritation or bad breath.
To brush your teeth properly, you need the tools of the trade - a toothbrush and a fluoride toothpaste.

Choosing a toothbrush may not seem as easy as it once was, with such a vast array in the shops. Dentists advise that you choose a brush with a small head, because this is easier to move around your mouth and get into all the nooks and crannies. Some people like to use an electric brush, but studies have shown that manual brushes are just as good if not better than most electric brushes. What is more important is the technique you use. It's important to use a circular action rather than a scrubbing, up and down action. This will give your teeth the best clean. Take time to brush the hard-to-reach areas like right at the very back of your mouth and behind your teeth, as this is where bacteria can accumulate, storing up problems for later.

When you're choosing a toothpaste, the most important thing to look for is that it contains fluoride. This is a vital ingredient and helps to protect teeth against decay. Most of the leading brands will contain fluoride, as will supermarket and chemists' brands.

If you have dentures, it's just as important to keep them clean. Looking after them can be much easier than looking after your natural teeth, as you can take them out and have a good look to make sure you haven't left any old food behind. To give them the best clean, follow these simple tips:
 

• Clean your denture over a basin of water - then, if you drop it, it's unlikely to get damaged
• Make sure you brush your denture every day, just as you would your own teeth. You should use a soft to medium brush - which won't scratch the denture - and either your regular toothpaste or soap and water. Make sure you rinse it before putting it back in your mouth.
• You can also soak your denture using a special solution or tablets. Remember, though, that you will still need to brush the denture to make sure it's really clean. Again, you'll need to rinse it before putting it back in your mouth.

Dentures and Implants
Dental implants

Dental implants are one way of replacing missing teeth. The way they are mounted onto posts and inserted into the jaw during surgery means that they look and feel just like ordinary teeth.

Although there are many advantages to having implants, they are not suitable for everyone. You need to have healthy gums and be in good general health. You also need enough jawbone to take the posts and support the replacement teeth. Some chronic diseases, such as diabetes, osteoporosis or chronic sinus problems could interfere with healing and make implants more likely to fail.

If you choose to have implants, you will undergo surgery twice or more over a period of several months. Because they are a complicated form of treatment, implants can also be expensive.

Your dentist will go through each stage of the treatment with you before it begins and also give you a timetable for completing treatment. You might be referred to a specialist.
The dentist will expose the bone in the jaw where the tooth is missing. Then he will drill a hole and insert a metal post into the bone. This is usually done under a local anaesthetic, but sometimes sedation or, if you are in hospital, a general anaesthetic is used. The gum is then stitched over the post and it's left to heal for several months, while the bone grows around the post, making it secure.

After this period, there will be second operation then happens, in which replacement teeth are mounted onto the metal post. This requires a small cut in the gum above the implant. The replacement teeth might be single or in a group, and possibly as a 'bridge', attached to neighbouring natural teeth. They may be fixed permanently or attached in a way that lets you remove them for cleaning.

After surgery, it's absolutely essential to maintain good mouth hygiene and visit your dentist regularly.

Removable dentures

Removable dentures are one of the most common ways of replacing missing teeth. Dentures can replace either a few teeth - a partial denture - or a whole set - complete dentures. Some people are worried that others will be able to tell immediately that they have dentures, but the quality and appearance of today's dentures is far better than ever before.

If you have lost some teeth, dentures can improve the way you look, bite, chew and speak. The teeth that are left are protected from wear and tear. Without dentures, the natural teeth may move or tilt, stopping your teeth biting together properly. Dentures can be fitted immediately after teeth have been taken out so that nobody will know that you have had a tooth out. These are called 'immediate' dentures.

Dentures will never feel like your own teeth and it can take time to get used to them. If you haven't had a denture before, the dentist will want to explain the difficulties of wearing dentures, as well as the benefits and how you should look after your new dentures and the teeth you have left.

Complete dentures are best made of acrylic (plastic). Partial dentures can also be made wholly of acrylic. Alternatively, they can consist of acrylic teeth on a light metal alloy base: this type of partial denture is more secure and less bulky, but also more expensive.
To make sure that the dentures fit your mouth properly, the dentist uses a putty-like material to make moulds - called 'impressions' - of your mouth. A dental technician uses them to make models for the denture to be built on. Sometimes, second impressions are taken.

The technician makes wax blocks which fit the models. The dentist puts these in your mouth to record the position of your jaws in relation to each other. The dentist then trims and seals the wax blocks to show the technician how your teeth should bite together and the shape to make the denture.

A trial denture is made and put in your mouth. The dentist will ask you how it fits, feels and looks before they make any final changes.

The trial denture then goes back to the technician who permanently fixes the teeth. The denture is then ready to use. The dentist may want to see you again fairly soon to see how you are getting on with the denture. If there are problems, they can make small adjustments

Cleaning your dentures

If you have dentures, it's important to keep them clean. Looking after them can be much easier than looking after your natural teeth, as you can take them out and have a good look to make sure you haven't left any old food behind. To give them the best clean, follow these simple tips:

• Clean your denture over a basin of water - then, if you drop it, it's unlikely to get damaged
• Make sure you brush your denture every day, just as you would your own teeth. You should use a soft to medium brush - which won't scratch the denture - and either your regular toothpaste or soap and water. Make sure you rinse it before putting it back in your mouth.
• You can also soak your denture using a special solution or tablets. Remember, though, that you will still need to brush the denture to make sure it's really clean. Again, you'll need to rinse it before putting it back in your mouth.